I applaud President Obama for his efforts. I too believe that everyone deserves proper healthcare and that access to healthcare must be a right for all. But I think Washington is barking up the wrong tree. They're busy arguing about what amounts to health insurance reform, while what this country needs is true health care reform.
Interestingly, what is happening in Washington mirrors much of what we do in Western Medicine. We suppress symptoms instead of dealing with the root causes of the problem. All the options on the table now only address how we pay for healthcare, rather than why we are unhealthy and how we change that. If we don't change why we are unhealthy, not only are we unlikely to secure better medical outcomes, but it will probably bankrupt us too. In terms of getting better health care or becoming a healthier nation we have to make serious changes. We will only flourish if we address the root causes of the problem.
As a nation, we're highly skilled in crisis care and the treatment of life- threatening diseases. But we're rank amateurs when it comes to the equally important issues of preventative care and the management of chronic diseases such as diabetes, heart disease, obesity and many cancers. True healthcare reform needs to provide greater support to these areas as at least 75% of our medical costs are spent on treating these chronic diseases.
Recently on Huffington Post, four physician colleagues of mine Andrew Weil, Dean Ornish, Deepak Chopra, and Mark Hyman all eloquently articulated the problems we face. I won't repeat their arguments, instead I will present some facts about our system and will offer some recommendations many of which complement their thoughts.
I don't claim to have all the answers and some of these suggestions may seem unrealistic given our current system, but to fix health care in this country we need radical change.
In addition to my strong belief that any civilized society should guarantee healthcare for all its citizens without exception, here are 10 recommendations that I feel should be an essential part of any health care reform.
1) Invest in educating the public in self care
Ultimately the most effective way to increase the health of the nation and to cut healthcare costs in the long term is if we all take responsibility for our own health and learn prevention. It has been repeatedly shown that what we eat, how we respond to stress, how much exercise we get, our exposure to chemicals and the quality of our relationships and social support systems is powerful medicine. Unfortunately most of us don't know how to do this, so training health coaches to go out and educate the public would help.
2) Motivate people by rewarding lifestyle changes that foster health.
We should encourage and reward people who take responsibility for their own health. Help pay for or give tax deductions for gym memberships, yoga classes, cooking classes, instruction in relaxation techniques, and appropriate doses of certain supplements like Vitamin D, fish oils and probiotics. Visits to Healthcare Professionals for lifestyle counseling and disease prevention should be encouraged and covered.
3) Educate Doctors and other Healthcare Practitioners in nutrition, exercise, stress reduction techniques and natural remedies.
Hundreds of billions of dollars are wasted by doctors when they request unnecessary tests, over prescribe drugs (often with harmful effects), and perform unnecessary surgeries. Many of these services are reimbursed because of lobbyists and clinical practice guidelines established through industry influence or custom, not because the reasons for doing them are scientifically sound. Educating doctors to start with the least expensive, least harmful and least invasive treatments, while having a backup of the "big guns" when needed, would prevent a lot of unnecessary expense. The Institute of Functional Medicine, has a clinical model that is extremely effective for the prevention, assessment and management of chronic diseases. It has already trained over 10,000 doctors and should become part of every doctor's training.
4) Reimburse doctors for their time in preventing and managing chronic diseases.
In the current model, the reimbursement structure financially rewards crisis care and disease care, but not prevention, early intervention and effective long-term management. But we now understand that chronic diseases develop over many years because of an individual's genetic makeup combined with their lifestyle, environment and social network. The effectiveness of a Functional Medicine approach to chronic disease has been demonstrated, so the tools we need to reduce the burden of chronic disease are available. But it requires more than just a 10 minute consultation. To encourage doctors to practice preventative care, they need to be paid not only for expensive procedures, but for the time they spend with patients supporting them through these changes. In addition, we need to train health coaches or other health care practitioners to provide this personalized, preventive and participatory medicine.
5) Practice the Precautionary Principle.
In brief, the Precautionary Principle states that: "When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically." Before chemicals or other engineered substances that may impair body functions and cause diseases are put into our food, water, soil, air, cosmetics and home products, they need to be proven safe. At the moment, our attitude to these chemicals is that they are innocent until proven guilty. They should be assumed guilty until proven innocent.
6) Protect our food supply and encourage healthy eating
The Health and Agriculture departments should work together and apply the Precautionary Principle to our food production. Harmful pesticides, additives and other chemicals should not be used in our food production until proven safe.
Food labeling should be honest, for instance, irradiated and GMO foods should be labeled as such.
Local farmers and farmers markets and the consumption of fresh and seasonal foods should be actively supported and encouraged.
7) Feed our children healthily and educate them responsibly.
Serve fresh unprocessed food for school lunches, food that's nutritious instead of just cheap and convenient. Eliminate junk food and soda vending machines from all schools (and while we are at it, from all public buildings and airports).
Put organic vegetable gardens in schools especially in low-income areas. This not only provide kids with nutritious food to eat, but it also teaches them about the importance of nutrition in general and how to grow their own food.
Ban the advertising and marketing of junk food, sodas and fast food to children...$13 billion is spent annually on it. We should not be convincing children--or adults--to buy products that harm them.
Don't eliminate physical education programs from the schools as is happening now with budget cuts.
8) Subsidize healthy foods like fruits and vegetables.
Most of the billions of dollars in subsidies go to huge agribusinesses that produce feed crops, such as corn and soy. By funding these crops, the government supports the production of factory farmed meats and dairy products. Corn is also made into high fructose corn syrup. All of these contribute to our growing rates of obesity and chronic disease. Fruit and vegetable farmers, on the other hand, receive less than 1 percent of government subsidies. Switch these subsidies around.
9) Remove corporate influence from healthcare.
Corporate influence should not be what drives the system. According to The Washington Post, 1.4 million dollars a day is being spent by healthcare interests to get what they want in the new health bill. There are 4 lobbyists for every Congressman on Capitol Hill. They should be banned. Unfortunately the self interest of these parties often works against outcomes that would better serve our collective and societal good.
Stop direct-to-consumer drug advertising and radically limit the more than $30 billion that is spent by the pharmaceutical industry on marketing drugs to physicians.
10) Give everyone freedom of choice
Lastly, people should have the freedom to choose what method of treatment they want to follow, whether conventional or alternative, western or non western, traditional or non traditional.
Focusing only on how people can get access to costly disease treatment, without having the more important discussion about how lifestyle changes can be implemented to prevent these diseases in the first place, is like rearranging the deck chairs on the Titanic. We will simply be perpetuating a flawed and costly healthcare model. For the sake of not only our personal health, but also for the financial health of the nation, we must address the causes that underlie the prevalence of chronic disease that we are experiencing. Unless we address why people are getting sick or the underlying mechanisms of their illnesses, our system will lack a solid foundation. Unless we change our disease care model to a true health care system, we are bound to both overpay and underachieve in the long run.
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Frank Lipman MD is an internationally recognized expert in the fields of Integrative and Functional Medicine. A practicing physician, he is the founder and director of the Eleven Eleven Wellness Center in NYC, where for over 20 years his personal blend of healing has helped thousands of people reclaim their vitality and recover their zest for life.
To bring his approach to a wider audience and not just his NYC patients, he recently created Eleven Eleven Wellness and Total Renewal, a leading edge integrative health program to get your health on track.
He is the author of REVIVE: Stop Feeling Spent and Start Living Again (2009) (previously called SPENT) and TOTAL RENEWAL: 7 key steps to Resilience, Vitality and Long-Term Health (2003).
Dr. Lipman lectures throughout the world on chronic disease prevention and is very involved with and sits on the Board of two non profits from his native South Africa, the Ubuntu Education Fund and Monkeybiz. He also has an intense passion for World music and is a frustrated DJ.
To hang with Frank, visit his blog, follow him on Twitter or join his Facebook community today.
Follow Dr. Frank Lipman on Twitter: www.twitter.com/drfranklipman
Make sure that responsible owners/guardians of companion animals are allowed to have them. In my experience with Citizens for Pets in Condos, physicians who know the health benefits of having animal companions can write letters to document the need for emotional support animals, but boards of condo associations resist allowing the animals to stay.
Help the people who where devastated by Katrina by fixing up the area.
Bring the troops home from Iraq.
Where is the money coming from to pay for the bill?
The government in most cases is inefficient, ineffective and filled with corruption.
If the healthcare provided is not equivalent to what the politicians receive then the bill should not pass.
Lets improve the economy first by stopping companies from sending jobs overseas.
What is the level of quality that the healthcare bill will provide?
I thank you profusely for this post. There seem to be a lot of MD's who get it, like you do, probably a majority.
An expansion and commentary to point #8 Subsidize healthy foods like fruits and vegetables:
This just goes to show how everything that has gone wrong in this country in the last half century is so inter-related, in this case to fix part of our health problems means fixing our agricultural policies, means fixing our energy problems, means fixing our poverty problems, means fixing our transportation problems, means fixing our lack of aggressive industrial policies, means fixing our political/lobbying problems. There are hundreds of thousands of neighborhoods (mostly poorer, urban and rural) in this country where without a vehicle or the land to grow it on it is virtually impossible for citizens to purchase healthy food, whatever the cost. The bad food is the cheapest food and for far too many the only food.
As you say, driven by lobbied subsidies and for profit medicine we have been reduced to patching together what in many cases is going wrong with our bodies because of bad life choices and sustenance, rather than promoting healthy choices that allow our bodies to run as they were intended and to heal themselves in many instances. Done correctly healthcare should be in large part a trauma exercise. But patching is far more profitable.
Thanks again!
Democracy is where no one is allowed to enrich himself upon your misery. But not so in capitalist medicine which allows those with a rich diet and pleasure filled lifestyle to destroy our healthcare system and our economy.
For those who walk into a fast food restaurant do it knowing full well that half of the calories they are about to eat will be pure fat. Comes now a democratic healthcare system to save the day:
(1) Those who eat a diet that is 25% or higher in fat must pay for all their medical expenses until all their savings have been exhausted.
(2) Those who have no medical expenses shall at the end of each year receive a check for $2,000.
(3) We give the medical industry over $8,000 each year for every man, woman and child in America. This must be reduced by half to equal the healthcare costs of other industrialized nations.
So why did this author doctor treat the root cause of our rotten health in such a low priority way, such as, "what we eat, how we respond to stress..."
Surely there is something very rotten in the medical industry, and just as surely it all has to do with money. For family doctors are not required to take a single course in nutrition, they get a 40% referral fee, a full 40% of all money paid to a specialist they recommend, and virtually all retire millionaires.
REFORM HEALTH -- BANKRUPT PROCESSED FOOD AND MEDICAL INDUSTRY
For true healthcare reform would require a high tax on refined food, and a diet with only 10% fat. Which would close down half the processed food plants, bankrupt most hospitals and make our super-intelligent super-rich most unhappy.
http://www.pnhp.org/
After reading your article, the question I have is, "How do we go about making this happen?"
Best Regards,
Devon White
EAT NOTHING PROCESSED BY MAN OR ANIMAL
That would be real health care reform, while what is going on is a needed band-aid, it is not much more, and will not lead to real improvements in health and a real drop in costs.
Read the article, it is not perfect, but it looks like the first real step in that direction that I've seen.